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General NPI Number Information
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NPI Number | 1679555866
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Entity Type | Individual
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Provider Name | EDWIN F ETCUBANEZ MD
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Gender | Male
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Dates
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Enumeration Date | 11/15/2005
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Last Update Date | 09/10/2013
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Provider Practice Location Address
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Address Line | 2100 KANOELEHUA AVE B9
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City | HILO
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State | HI
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Zip | 96720-6500
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Country | US
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Telephone | 808-981-1700
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Fax | 808-981-1701
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Provider Business Mailing Address
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Address Line | 2100 KANOELEHUA AVE B9
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City | HILO
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State | HI
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Zip | 96720-6500
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Country | US
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Telephone | 808-981-1700
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Fax | 808-981-1701
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 4301045023
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License Number State | MI
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